Systems and methods for guided relay delivery of medication

ABSTRACT

Guided relay infusion systems and methods are provided. A guided relay infusion system may be a portion of an infusion pump that can simultaneously deliver a medical fluid from two syringes. When a first one of the syringes is running out of the medical fluid and a second one of the syringes is more full of the medical fluid than the first one of the syringes, guided relay messages are provided for a relay handoff from the first one of the syringes to the second one of the syringes that ensures a smooth continuous delivery of more of the medical fluid than the first one of the syringes holds.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a 371 of PCT/US2017/056651, filed on Oct. 13, 2017,which claims priority to U.S. provisional application 62/409,316, filedon Oct. 17, 2016.

TECHNICAL FIELD

The present disclosure generally relates to the administration ofmedical fluids and, in particular, relates to systems and methods formultiple syringe delivery of medical fluids.

BACKGROUND

Medical fluids are often delivered to a patient via a syringe. However,in some scenarios, delivery of a medical fluid from a single syringe canbe problematic.

SUMMARY

Aspects of the subject technology relate to systems and methods ofguided relay of infusion from one container source to another containersource for the same medication.

In accordance with certain aspects, a system is provided that includes afirst actuable component configured to couple to a plunger of a firstsyringe containing a medication, a second actuable component configuredto couple to a plunger of a second syringe containing the samemedication, a display, and a processor. The processor is configured tooperate the first actuable component to move the plunger of the firstsyringe at a first rate, operate the second actuable component to movethe plunger of the second syringe at a second rate while operating thefirst actuable component at the first rate, and operate the display toprovide a message that describes a decrease in the first rate and acorresponding increase in the second rate.

In accordance with certain aspects, a computer-implemented method isprovided that includes operating a first syringe to administer a medicalfluid from the first syringe, detecting a second syringe, and providingone or more guided relay messages to a user for transitioning fromadministering the medical fluid from the first syringe to administeringthe medical fluid from the second syringe.

In accordance with certain aspects, an infusion pump having processingcircuitry and non-transitory machine-readable media is provided, thenon-transitory machine-readable media storing instructions that, whenexecuted by the processing circuitry cause the processing circuitry tooperate a first syringe that is coupled to the infusion pump to move amedical fluid from the first syringe into infusion tubing, detect asecond syringe coupled to the infusion pump, and provide one or moreguided relay messages on a display of the infusion pump fortransitioning from administering the medical fluid from the firstsyringe to administering the medical fluid from the second syringe.

It is understood that various configurations of the subject technologywill become readily apparent to those skilled in the art from thedisclosure, wherein various configurations of the subject technology areshown and described by way of illustration. As will be realized, thesubject technology is capable of other and different configurations andits several details are capable of modification in various otherrespects, all without departing from the scope of the subjecttechnology. Accordingly, the summary, drawings and detailed descriptionare to be regarded as illustrative in nature and not as restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide furtherunderstanding and are incorporated in and constitute a part of thisspecification, illustrate disclosed embodiments and together with thedescription serve to explain the principles of the disclosedembodiments. In the drawings:

FIG. 1A is a diagram illustrating a system for administering medicalfluid to a patient using multiple syringes according to certain aspectsof the present disclosure.

FIG. 1B is a diagram illustrating multiple syringes for delivering amedical fluid according to certain aspects of the present disclosure.

FIG. 2 illustrates exemplary flow rates over time during administrationof a medical fluid from two syringes according to certain aspects of thepresent disclosure.

FIG. 3 illustrates various exemplary patient hazards duringadministration of a medical fluid from two syringes according to certainaspects of the present disclosure.

FIG. 4 illustrates exemplary flow rates over time during guided relayadministration of a medical fluid from two syringes according to certainaspects of the present disclosure.

FIG. 5 illustrates additional features of exemplary flow rates over timeduring guided relay administration of a medical fluid from two syringesaccording to certain aspects of the present disclosure.

FIGS. 6A-6N illustrate display screen examples that may be displayed atvarious stages during an exemplary process for guided relayadministration of a medical fluid from two syringes according to certainaspects of the present disclosure.

DETAILED DESCRIPTION

The detailed description set forth below describes variousconfigurations of the subject technology and is not intended torepresent the only configurations in which the subject technology may bepracticed. The detailed description includes specific details for thepurpose of providing a thorough understanding of the subject technology.Accordingly, dimensions may be provided in regard to certain aspects asnon-limiting examples. However, it will be apparent to those skilled inthe art that the subject technology may be practiced without thesespecific details. In some instances, well-known structures andcomponents are shown in block diagram form in order to avoid obscuringthe concepts of the subject technology.

It is to be understood that the present disclosure includes examples ofthe subject technology and does not limit the scope of the appendedclaims. Various aspects of the subject technology will now be disclosedaccording to particular but non-limiting examples. Various embodimentsdescribed in the present disclosure may be carried out in different waysand variations, and in accordance with a desired application orimplementation.

In the following detailed description, numerous specific details are setforth to provide a full understanding of the present disclosure. It willbe apparent, however, to one ordinarily skilled in the art thatembodiments of the present disclosure may be practiced without some ofthe specific details. In other instances, well-known structures andtechniques have not been shown in detail so as not to obscure thedisclosure.

Medical fluids such as inotropes may be provided to a patient from oneor more syringes. Inotropes may be provided over a period of time suchas a 24 hour period from one syringe. However, in some scenarios, asyringe for delivery of a medical fluid such as an inotrope may need tobe changed more frequently than the time for a delivery of a completedose, for example, depending on a patient condition. Medical fluids suchas inotropes also have a short (e.g., 2 minute) half-life and the wrongconcentration of these drugs in the body can cause negative and/ordangerous effects for a patient. Accordingly, a new syringe containingrelatively a newer inotrope than a current syringe from which theinotrope is being administered may be needed during continuousadministration of the inotrope. Example inotrope drugs include DOPamine,DOBUtamine, NORadrenalin, and Fusoemide.

In accordance with some aspects, systems and methods may be provided forguided relay of medical fluid administration from multiple syringes. Forexample, a first syringe may be provided from which a medical fluid isadministered to a patient (e.g., as controlled by an infusion pump) fora first period of time. A second syringe may be provided from which themedical fluid is administered during a second period of time after thefirst period of time. During a transition period between the first andsecond periods of time, a combined administration of the medical fluidmay be provided from the first and second syringes. During thetransition period, the administration of the medical fluids may berelayed from the first syringe to the second syringe by slowing thedelivery rate of the first syringe while simultaneously increasing thedelivery rate of the second syringe to maintain a constant overalldelivery rate. Various guided relay messages such as guiding alerts andnotifications may be provided (e.g., by the infusion pump and/or othermonitoring equipment) to prevent patient hazards that may occur duringsuch a relay transition, as described in further detail hereinafter.

In accordance with some aspects, systems and methods for guided relay ofmedical fluid administration as disclosed herein may help ensure that aclinician can transition their patients from a current syringe to newsyringe with drug delivery continuity and with minimal increases toworkload. Systems and methods for guided relay of medical fluidadministration as disclosed herein may help establish a combined doseand delivery rate from multiple syringes at a desired delivery rate forthe patient and monitor and guide a clinician such as a nurse tomaintain the established dose and delivery rate at the desired dose anddelivery rate for a consistent end patient effect over the course of(e.g., inotrope) syringe transition.

In accordance with some aspects, systems and methods for guided relay ofmedical fluid administration as disclosed herein may help preventpatient errors by, for example: (i) monitoring the total combined fluidrate of two or more syringes to ensure the total combined fluid ratecontinuously meets the appropriate target levels for delivery to thepatient, (ii) displaying one or more reminders of upcoming and/or pastdue steps for the syringe transition, the reminders being visible at thebedside and remotely in some embodiments, and (iii) providing combinedinfusion data to a patient data management system (PDMS) in order toallow easier documentation of the infusion.

In accordance with some aspects, systems and methods for guided relay ofmedical fluid administration as disclosed herein may help preventpatient hazards such as (A) a patient crashing due to inconsistentmedication in their blood stream, potentially caused by anon-therapeutic combined rate from multiple syringes, (B) a cliniciansuch as a nurse missing a syringe transition window causing a firstsyringe to go empty, and/or (C) documentation errors due to the combinedinfusion being a sum of two pump modules associated with the twosyringes.

In accordance with some aspects, monitoring the total combined fluidrate of two or more syringes to ensure the total combined fluid ratecontinuously meets the appropriate levels for delivery to the patientmay help prevent medication errors associated with hazard A describedabove. In accordance with some aspects, displaying one or more remindersof upcoming and/or past due steps for the syringe transition may helpprevent medication errors associated with hazard B described above. Inaccordance with some aspects, providing combined infusion data to apatient data management system (PDMS) in order to allow easierdocumentation of the infusion may help prevent medication errorsassociated with hazard C described above.

In some embodiments, guided relay systems may provide notifications toone or more vital signs monitoring systems that a syringe transition isoccurring or is about to occur. The guided relay system and/or the vitalsigns monitoring system may provide relatively tighter vital signslimits for the vital signs monitoring systems during the transition. Inaccordance with some aspects, providing notifications to one or morevital signs monitoring systems that a syringe transition is occurring oris about to occur may help prevent medication errors associated with oneor more of hazards A, B, and C described above.

In some embodiments, guided relay systems may include one or moresensors disposed at one or more locations within infusion lines tomeasure actual flow rates within or between different segments ofinfusion lines. Flow rates may be displayed to a clinician such as anurse for monitoring of the transition. In accordance with some aspects,providing one or more sensors disposed at one or more locations withininfusion lines to measure actual flow rates within or between differentsegments of infusion lines may help prevent medication errors associatedwith one or more of hazards A, B, and C described above.

In some embodiments, guided relay systems may receive patient conditioninformation such as vital signs information from a vital signsmonitoring system and may dynamically adjust the period during whichflow from one or more medication syringes will be controlled based uponthe patient condition information. In accordance with some aspects,dynamically adjusting the period during which flow from one or moremedication syringes will be controlled based upon the patient conditioninformation may help prevent medication errors associated with one ormore of hazards A, B, and C described above.

In some embodiments, guided relay systems may provide remote controlaccess for remote adjustment of an infusion rate (e.g., back to a safersetting) depending upon vital signs readings from the patient (e.g.,from a vital signs monitoring system). In accordance with some aspects,providing remote control access for remote adjustment of an infusionrate (e.g., back to a safer setting) depending upon vital signs readingsfrom the patient (e.g., from a vital signs monitoring system) may helpprevent medication errors associated with one or more of hazards A, B,and C described above.

Turning now to the drawings, FIG. 1A shows an exemplary a system 100 foradministration of medical fluids. As shown in FIG. 1A, system 100 mayinclude infusion pump 102 and one or more pump modules such as pumpmodules 104 for controlling administration of medical fluids fromintravenous (IV) bags by manipulation of tubing coupled to the IV bagsand syringe module 106. One or more pump modules 104, syringe modules106, and/or other modules such as vital signs monitoring modules (e.g.,blood pressure, heart rate, oxygen saturation (Spo2), partial pressureor maximal concentration of carbon dioxide (EtCo2), or other vital signsmonitors) or identification modules (e.g., scanning modules forcapturing a patient identifier (ID), a clinician ID and/or druginformation) may be coupled to and/or operated by infusion pump 102.

Although only one syringe module 106 is shown in FIG. 1A, two, three, ormore than three syringe modules may be coupled to and/or operated byinfusion pump 102. For example, infusion pump 102 may include processingcircuitry (e.g., one or more central processing units or dedicatedprocessor modules) and non-transitory machine-readable media (e.g.,volatile or non-volatile memory including permanent and/or removablememory). The non-transitory machine-readable media may store sequencesof instructions or code that, when executed by the processing circuitrycauses the processing circuitry to operate one or more of pump modules104, syringe module 106, and/or other modules or components (e.g.,display 112, input/output components 114, and/or communicationscircuitry for communications with other systems or devices). Thenon-transitory machine-readable media may store sequences ofinstructions or code that, when executed by the processing circuitrycauses the processing circuitry to perform a guided relay process fortransitioning delivery of a medical fluid from a first syringe in afirst syringe module 106 to delivery of the medical fluid from a secondsyringe in a second syringe module 106. In this way, a guided relaysystem may be incorporated within an infusion pump system.

Infusion pump 102 may operate multiple syringe modules 106 to controldelivery of a medical fluid from multiple syringes, each disposed in arespective syringe recess 108 of a corresponding syringe module (e.g.,by controllably depressing a plunger of the syringe by moving anactuable component such as actuating platform 110). FIG. 1B shows twoexemplary syringes 150, each disposed in a corresponding syringe recess108 of a respective syringe module 106.

As shown in FIG. 1B, a plunger 151 of each syringe 150 is mechanicallycoupled to actuable component 110 of the syringe module so that pump 102can actuate the plunger to control the flow of a medical fluid from thesyringe to medical tubing 152 (e.g., infusion tubing). The medicaltubing may be coupled to a patient receiving the medical fluidintravenously. As shown in FIG. 1B, sensors 154 such as flow sensors maybe disposed in the medical tubing for sensing a flow rate of the medicalfluid in the tubing (e.g., for monitoring, such as by pump 102, of theindividual flow rates from syringes 150 and/or the overall flow ratefrom both syringes). It should also be appreciated that the individualflow rates from syringes 150 and/or the overall flow rate from bothsyringes can also, or alternatively, be monitored by monitoring themotion of actuating members 110 for known syringe sizes and volumes. Asdescribed in further detail hereinafter, one or more alerts may begenerated based on a measured flow rate as obtained using one or more ofsensors 154.

Although the guided relay processes described herein are sometimesdescribed as being performed by an infusion pump 102 coupled to thesyringe module, it should be appreciated that in other embodiments,guided relay processes may be performed entirely, or in part, by othersystems separate from the infusion pump system such as by a standaloneguided relay system that is communicatively coupled to infusion pump102.

FIG. 2 shows a flow diagram illustrative exemplary flow rates during atransition period 200 during which administration of a medical fluidfrom a first syringe is relayed or “handed off” smoothly to a secondsyringe. As shown in FIG. 2, at block 210 during a first period of time201, a first or current syringe 152 with remaining medical fluid may berunning (e.g., being operated by depressing plunger 151 of the firstsyringe with a first member 110) to deliver the medical fluid attherapeutic rate 202A of, for example, 2 mL/hr. During first period oftime 201, at block 212 a second or replacement syringe 150 startsrunning (e.g., being operated by depressing plunger 151 of the secondsyringe with a second member 110) to deliver the same medical fluid at apriming rate 204A (e.g., 0.5 mL/hr) (e.g., to prime a secondary infusionline 154 from the second syringe).

During a second period of time 203 (e.g., after the secondary line hasbeen primed), at block 214 the replacement syringe may continue to runat the priming rate 204A while the current syringe delivery rate isreduced (e.g., automatically or by a clinician such as a nurse) to arelatively lower rate 202B (e.g., 1.5 mL/hr) to accommodate delivery ofthe medical fluid at the priming rate from the replacement syringe.

Following second period of time 203, the delivery rate from the firstsyringe may be decreased and the delivery rate from the second syringemay be correspondingly increased (e.g., in 0.5 mL/hr increments), untildelivery of the medical fluid is transitioned from the first syringedelivery to the second syringe delivery. For example, during a thirdperiod of time 205, delivery from the first syringe may be provided at arate 202C (e.g., 1 ml/hr) that is equal to the delivery rate 204B fromthe second syringe. During a fourth period of time 207, delivery fromthe first syringe may be reduced to a rate 202D (e.g., 0.5 ml/hr) andthe delivery from the second syringe may be correspondingly increased toa deliver rate 204C (e.g., 1.5 ml/hr). During a fifth period of time209, delivery from the first syringe may be reduced to a rate 202E(e.g., delivery from the first syringe may be stopped by reducingdelivery to a rate of 0 ml/hr) and the delivery from the second syringemay be correspondingly increased to a delivery rate 204D (e.g., 2.0ml/hr) equal to the therapeutic rate to complete the transition andtakeover of delivery by the second syringe. The delivery from the firstsyringe may be stopped before all of the fluid in the first syringe hasbeen delivered to ensure a smooth transition and consistent takeover bythe second syringe.

FIG. 3 shows the chart of FIG. 2 with indicators corresponding tovarious times during transition period 200 at which one or more of thepatient hazards A, B, and C (described above) may occur without the useof a guided relay system as described herein.

FIG. 4 shows a flow diagram of various operations that may be performedfor guided relay, overlaid on the chart of FIG. 2. As shown in theexample of FIG. 4, at block 400, a system such as a guided relay systemfor an infusion pump detects a second infusion (e.g., a second syringewhen a first syringe is being operated to deliver a medical fluid) isbeing prepared and asks the nurse to enter a “Guided Relay” mode (e.g.,by providing a prompt on display 112). At block 402, within, forexample, three minutes of the next transition of the flow rates, aninformational alert message may be provided by the guided relay system(e.g., an alert message may be displayed or flash on a display of thesystem such as display 112 of FIG. 1). At block 404, if it is determinedby the guided relay system (e.g., based on sensors in the syringerecesses, based on actuation of syringe plungers or based on sensorinformation from within the infusion lines) that the scheduledtransition did not occur within a certain period (e.g., three minutes)after the scheduled transition time, an alarm may sound (e.g., using aspeaker of the infusion pump). At block 406, infusion information may becombined and provided to the PDMS by the guided relay system.

FIG. 5 shows another flow diagram of various operations that may beperformed for guided relay overlaid, on the chart of FIG. 2. As shown inthe example of FIG. 5, at block 500, a system such as a guided relaysystem for an infusion pump detects a second infusion (e.g., a secondsyringe when a first syringe is being operated to deliver a medicalfluid) is being prepared and asks the nurse to enter a “Guided Relay”mode. Numbers of steps and intervals for the guided relay may beautomatically adjusted by the system based upon patient information. Atblock 502, patient vital signs monitoring limits may be set more tightlyduring transition period 200. For example, acceptable limits on patientblood pressure, blood oxygen content, heart rate, etc. may be modifiedso that changes in the patient vital signs that may be caused by changesin the infusion can be quickly detected and addressed (e.g., byreturning to a previous infusion state). At block 504, one or moresensors within different components of the line (e.g., one or moresensors within infusion tubing associated with an individual syringeand/or one or more sensors within tubing that receives medical fluidfrom both syringes) may provide signals for measuring the actual flowrate therein. Signals from the sensors may be used to generate a warningif the line management prevents consistent transition. At block 506, ifone flow rate transition causes a drop in the vital signs (e.g., a dropthat violates one of the tightened limits), the pumps may revert back tothe previous step's flow rate settings and the system may generate analarm or alert. Any or all of the operations described in connectionwith FIG. 5 may be performed separately or together with and/or all ofthe operations described in connection with FIG. 4.

FIG. 6A shows an exemplary display screen 700 generated by a guidedrelay system such as system 100 of FIG. 1. For example, display screen700 may be displayed using display 112 of FIG. 1 in someimplementations. In the example of FIG. 6A, display screen 700 showsmonitoring information 701 for a first drug (e.g., Propofol 1%) with afirst pump and monitoring information 703, 705, and 707 respectively forinfusions of insulin, Dopamine, and Dopamine with a second pump. Forexample, a first 50 mL syringe of DOPamine may be infusing at a flowrate of 2 mL/hr by a first syringe module and a clinician may prepare areplacement syringe of DOPamine and load the replacement syringe into asecond syringe module, putting the second syringe module on standby.

As shown in FIG. 6B, display screen 700 may be modified responsive todetection, by the guided relay system of two infusions of the samemedical fluid (e.g., DOPamine) by providing an alert 702 including avisual request for user input (e.g., a visual display of a question suchas “Two DOPamine infusions for this patient are detected, would you liketo start ‘Guided Relay’ mode?”). Options for responding such as “Yes”and “No” may also be provided in alert 702 as shown. The user (e.g., aclinician such as a nurse) may provide a user response to the guidedrelay system by entering, for example, “Yes” (e.g., using a touchscreeninput of display 112 or using input/output components 114 such asbuttons to enter a response).

As shown in FIG. 6C, responsive to receiving a “Yes” response to enterthe ‘Guided Relay’ mode, an additional alert 704 may be providedrequesting user confirmation or adjustment of the settings of the guidedrelay. For example, alert 704 may include a visual display of a questionsuch as “Would you like the ‘Guided Relay’ mode to be 3 steps over 60minutes?” as shown. Options for responding such as “Yes” and “No—AdjustSettings” may also be provided in alert 704 as shown. The user may enter“Yes” to accept the settings or “No—Adjust Settings” to enter a settingsmode in which the user can set the flow rates and/or transition periodsfor the guided transition.

As shown in FIG. 6D, responsive to receiving a “Yes” response to acceptthe guided relay settings, during a transition period for infusion ofthe medical fluid from both a first and second syringe, an indicator 708may be provided that indicates the second or replacement syringe and anindicator 710 may be provided that indicates the first or currentsyringe. Enlarged versions of indicators 708 and 710 are also shown inFIG. 6D showing how indicators 708 and 710 may be icons that visuallyidentify which syringe has a flow rate that is coming up or down. At aflow rate adjustment time, the guided relay system may provide a visualalert 706 including a message to instruct the clinician to make thefirst flow rate adjustment (e.g., by reducing a first flow rate of thefirst syringe and making a corresponding increase of a second flow rateof the second syringe). For example, visual alert 706 may include textsuch as “Guided Relay Message: Please reduce the emptying syringe to 1.5mL/hr and increase the relay syringe to 0.5 mL/hr” as shown. Anadditional icon 712 may be provided for any infusions undergoing guidedrelay.

As shown in FIG. 6E, a constant message 714 (e.g., a message includingtext such as “Guided Relay Message: 15 Minutes to Next Rate Change. NextRate Change will change the emptying syringe to 1 mL and the relaysyringe to 1 mL.”) may be available counting time to the next ratechange window. Message 714 may be displayed, for example, during timeperiod 203 of FIG. 4.

The display screen 700 of FIGS. 6A-6E may be a patient view of a guidedrelay system that displays infusion information for a particularpatient. As shown in FIG. 6F, a guided relay system such as system 100may also provide a ward view display screen 800 that displays infusioninformation such as display portions 802 and 804 for multiple patientsin a particular ward of a medical care facility. As shown in displayportion 802 of ward view 800, the ward view may include an indication805 of the drugs in guided relay and an information message 806 thatincludes an amount of time until the next changes in the rates for eachsyringe.

As shown in FIG. 6G, an additional alert 716 may be provided, during aset time window, to make a rate change. For example, the guided relaysystem may update display screen 700 to include a message in alert 716to indicate to the clinician that the rate change is in the time windowfor the rate change. For example, alert 716 may include text such as“Guided Relay Message: Within window to make a Rate Change. Pleasechange the emptying syringe to 0.5 mL and the relay syringe to 1.5 mL,”as shown.

As shown in FIG. 6H, an additional alert 718 may be provided if thescheduled rate change is not made. For example, the guided relay systemmay update display screen 700 to include a message in alert 718 thatincludes text such as “Guided Relay Message: 5 minutes beyond RateChange window. Please change the emptying syringe to 0.5 mL and therelay syringe to 1.5 mL.” An audio alarm may also be generated. Alert718 may be provided in a different color (e.g., red) from other alertsand/or messages e.g., yellow alerts and/or messages) to indicate a moreserious alert or that an error has been or is about to be made.

As shown in FIG. 6I, if the combined flow rate between the two DOPamineinfusions isn't at the intended combined rate (e.g., 2 mL/hr), an alert720 may be provided with, for example, text that states “Guided RelayMessage: Combined flowrate of DOPamine infusions are not at the desiredrate of 2 mL/hr!”

As shown in FIGS. 6J and 6K, following an appropriate adjustmentresponsive to alert 718 or 720, display screen 720 may be modified todisplay an alert 722 indicating the time and parameters for the nextflow rate change and then an alert 724 indicating that the time windowfor the next flow rate range change has arrived. Message 722 may bedisplayed, for example, during time period 205 of FIG. 4.

As shown in FIGS. 6L and 6M, following the transition associated withalerts 722 and 724, display screen 720 may be modified to display analert 726 indicating the time and parameters for the next flow ratechange and then an alert 728 indicating that the time window for thenext flow rate range change has arrived. Message 726 may be displayed,for example, during time period 207 of FIG. 4.

As shown in FIG. 6N, upon completion of the transition of the guidedrelay from the first syringe to the second syringe, display screen 700may be updated to include message 730 requesting a response related toreporting. For example, message 730 may include text such as “‘GuidedRelay’ is complete. Send syringe transition information to PDMS?” asshown. Options for responding such as “Yes” and “No—Keep it Separate”may also be provided in alert 730 as shown. The user may enter “Yes” totransmit syringe transition information to the PDMS or “No—Keep itSeparate” to prevent or delay the transmission.

Although the guided relay messages and alerts described herein includeexamples in which the guided relay messages and alerts includeinstructions for a clinician to make adjustments, it should beappreciated that the systems and methods described herein may also applyto guided relay messages and alerts that merely inform the clinicianthat flow rates for a relay transmission from a first syringe to asecond syringe (or a first IV bag to a second IV bag) as describedherein are being automatically adjusted (e.g., by an infusion pumpoperating both the first and second syringes).

The subject technology is illustrated, for example, according to variousaspects described above. Various examples of these aspects are describedas numbered concepts or clauses (1, 2, 3, etc.) for convenience. Theseconcepts or clauses are provided as examples and do not limit thesubject technology. It is noted that any of the dependent concepts maybe combined in any combination with each other or one or more otherindependent concepts, to form an independent concept. The following is anon-limiting summary of some concepts presented herein:

Concept 1. A computer-implemented method, comprising:

-   -   operating a first syringe to administer a medical fluid to a        patient from the first syringe;    -   detecting a second syringe;    -   providing one or more guided relay messages to a user for        transitioning from administering the medical fluid from the        first syringe to administering the medical fluid from the second        syringe.

Concept 2. The method of Concept 1 or any other Concept, whereintransitioning from administering the medical fluid from the firstsyringe to administering the medical fluid from the second syringecomprises, during a transition period, providing the medical fluid tothe patient simultaneously from the first syringe and the second syringefor at least a portion of the transition period.

Concept 3. The method of Concept 2 or any other Concept, whereintransitioning from administering the medical fluid from the firstsyringe to administering the medical fluid from the second syringefurther comprises, during the transition period, periodically reducing afirst flow rate of the medical fluid to the patient from the firstsyringe and correspondingly increasing a second flow rate of the medicalfluid to the patient from the second syringe.

Concept 4. The method of Concept 3 or any other Concept, whereinproviding the one or more guided relay messages comprises providing afirst guided relay message that includes instructions to the user toincrease the second flow rate of the medical fluid to the patient fromthe second syringe and reduce the first flow rate of the medical fluidto the patient from the first syringe.

Concept 5. The method of Concept 4 or any other Concept, whereinproviding the one or more guided relay messages comprises providing asecond guided relay message that includes a time until a next adjustmentof the first flow rate and the second flow rate.

Concept 6. The method of Concept 5 or any other Concept, whereinproviding the one or more guided relay messages comprises providing athird guided relay message that includes an alert that a scheduledadjustment did not occur.

Concept 7. The method of Concept 5 or any other Concept, whereinproviding the one or more guided relay messages comprises providing athird guided relay message that includes an alert that a combined flowrate corresponding to the first flow rate and the second flow rate isnot equal to a target flow rate.

Concept 8. The method of Concept 1 or any other Concept, wherein theoperating comprises operating the first syringe with a pump.

Concept 9. The method of Concept 1 or any other Concept, wherein theproviding comprises providing the one or more guided relay messagesusing a display of an infusion pump, the display operated by a guidedrelay system of the infusion pump.

Concept 10. An infusion pump comprising processing circuitry andnon-transitory machine-readable media, the non-transitorymachine-readable media storing instructions that, when executed by theprocessing circuitry cause the processing circuitry to:

-   -   operate a first syringe that is coupled to the infusion pump to        move a medical fluid from the first syringe into infusion        tubing;    -   detect a second syringe coupled to the infusion pump; and    -   provide one or more guided relay messages on a display of the        infusion pump for transitioning from administering the medical        fluid from the first syringe to administering the medical fluid        from the second syringe.

Concept 11. The infusion pump of Concept 10 or any other Concept,wherein the one or more guided relay messages comprises includes a timeuntil an adjustment of a first flow rate for the first syringe and acorresponding adjustment of a second flow rate for the second syringe.

Concept 12. The infusion pump of Concept 11 or any other Concept,wherein the corresponding adjustment of the second flow rate is equaland opposite to the adjustment of the first flow rate.

Concept 13. The infusion pump of Concept 11 or any other Concept;wherein the one or more guided relay messages comprises an alert that ascheduled adjustment of the first flow rate or the second flow rate didnot occur.

Concept 14. The infusion pump of Concept 11 or any other Concept,wherein the one or more guided relay messages comprises an alert that acombined flow rate corresponding to the first flow rate and the secondflow rate is not equal to a target flow rate.

Concept 15. A system, comprising:

-   -   a first actuable component configured to couple to a plunger of        a first syringe containing a medication;    -   a second actuable component configured to couple to a plunger of        a second syringe containing the same medication;    -   a display; and    -   a processor configured to:        -   operate the first actuable component to move the plunger of            the first syringe at a first rate;        -   operate the second actuable component to move the plunger of            the second syringe at a second rate while operating the            first actuable component at the first rate; and        -   operate the display to provide a message that describes a            decrease in the first rate and a corresponding increase in            the second rate.

Concept 16. The system of Concept 15 or any other Concept, wherein theprocessor is further configured to operate the display to provide amessage that describes a further decrease in the first rate and acorresponding further increase in the second rate.

Concept 17. The system of Concept 15 or any other Concept, furthercomprising infusion lines coupled to the first syringe and the secondsyringe and at least one flow sensor configured to obtain a measuredflow rate of the medication in the infusion lines.

Concept 18. The system of Concept 17 or any other Concept, wherein theprocessor is further configured to operate the display to generate,based on the measured flow rate, an alert that a scheduled adjustment ofthe first rate or the second rate did not occur.

Concept 19. The system of Concept 17 or any other Concept, wherein theprocessor is further configured to operate the display to generate,based on the measured flow rate, an alert that a combined flow ratecorresponding to the first rate and the second rate is not equal to atarget flow rate.

Concept 20. The system of Concept 15 or any other Concept, wherein themessage comprises instructions to decrease the first rate and increasethe second rate.

The present disclosure is provided to enable any person skilled in theart to practice the various aspects described herein. The disclosureprovides various examples of the subject technology, and the subjecttechnology is not limited to these examples. Various modifications tothese aspects will be readily apparent to those skilled in the art, andthe generic principles defined herein may be applied to other aspects.

A reference to an element in the singular is not intended to mean “oneand only one” unless specifically so stated, but rather “one or more.”Unless specifically stated otherwise, the term “some” refers to one ormore. Pronouns in the masculine (e.g., his) include the feminine andneuter gender (e.g., her and its) and vice versa. Headings andsubheadings, if any, are used for convenience only and do not limit theinvention.

The word “exemplary” is used herein to mean “serving as an example orillustration.” Any aspect or design described herein as “exemplary” isnot necessarily to be construed as preferred or advantageous over otheraspects or designs. In one aspect, various alternative configurationsand operations described herein may be considered to be at leastequivalent.

As used herein, the phrase “at least one of” preceding a series ofitems, with the term “or” to separate any of the items, modifies thelist as a whole, rather than each item of the list. The phrase “at leastone of” does not require selection of at least one item; rather, thephrase allows a meaning that includes at least one of any one of theitems, and/or at least one of any combination of the items, and/or atleast one of each of the items. By way of example, the phrase “at leastone of A, B, or C” may refer to: only A, only B, or only C; or anycombination of A, B, and C.

A phrase such as an “aspect” does not imply that such aspect isessential to the subject technology or that such aspect applies to allconfigurations of the subject technology. A disclosure relating to anaspect may apply to all configurations, or one or more configurations.An aspect may provide one or more examples. A phrase such as an aspectmay refer to one or more aspects and vice versa. A phrase such as an“embodiment” does not imply that such embodiment is essential to thesubject technology or that such embodiment applies to all configurationsof the subject technology. A disclosure relating to an embodiment mayapply to all embodiments, or one or more embodiments. An embodiment mayprovide one or more examples. A phrase such an embodiment may refer toone or more embodiments and vice versa. A phrase such as a“configuration” does not imply that such configuration is essential tothe subject technology or that such configuration applies to allconfigurations of the subject technology. A disclosure relating to aconfiguration may apply to all configurations, or one or moreconfigurations. A configuration may provide one or more examples. Aphrase such a configuration may refer to one or more configurations andvice versa.

In one aspect, unless otherwise stated, all measurements, values,ratings, positions, magnitudes, sizes, and other specifications that areset forth in this specification, including in the claims that follow,are approximate, not exact. In one aspect, they are intended to have areasonable range that is consistent with the functions to which theyrelate and with what is customary in the art to which they pertain.

It is understood that the specific order or hierarchy of steps, oroperations in the processes or methods disclosed are illustrations ofexemplary approaches. Based upon implementation preferences orscenarios, it is understood that the specific order or hierarchy ofsteps, operations or processes may be rearranged. Some of the steps,operations or processes may be performed simultaneously. In someimplementation preferences or scenarios, certain operations may or maynot be performed. Some or all of the steps, operations, or processes maybe performed automatically, without the intervention of a user. Theaccompanying method claims present elements of the various steps,operations or processes in a sample order, and are not meant to belimited to the specific order or hierarchy presented.

All structural and functional equivalents to the elements of the variousaspects described throughout this disclosure that are known or latercome to be known to those of ordinary skill in the art are expresslyincorporated herein by reference and are intended to be encompassed bythe claims. Moreover, nothing disclosed herein is intended to bededicated to the public regardless of whether such disclosure isexplicitly recited in the claims. No claim element is to be construedunder the provisions of 35 U.S.C. § 112 (f) unless the element isexpressly recited using the phrase “means for” or, in the case of amethod claim, the element is recited using the phrase “step for.”Furthermore, to the extent that the term “include,” “have,” or the likeis used, such term is intended to be inclusive in a manner similar tothe term “comprise” as “comprise” is interpreted when employed as atransitional word in a claim.

The Title, Background, Summary, Brief Description of the Drawings andAbstract of the disclosure are hereby incorporated into the disclosureand are provided as illustrative examples of the disclosure, not asrestrictive descriptions. It is submitted with the understanding thatthey will not be used to limit the scope or meaning of the claims. Inaddition, in the Detailed Description, it can be seen that thedescription provides illustrative examples and the various features aregrouped together in various embodiments for the purpose of streamliningthe disclosure. This method of disclosure is not to be interpreted asreflecting an intention that the claimed subject matter requires morefeatures than are expressly recited in each claim. Rather, as thefollowing claims reflect, inventive subject matter lies in less than allfeatures of a single disclosed configuration or operation. The followingclaims are hereby incorporated into the Detailed Description, with eachclaim standing on its own as a separately claimed subject matter.

The claims are not intended to be limited to the aspects describedherein, but are to be accorded the full scope consistent with thelanguage of the claims and to encompass all legal equivalents.Notwithstanding, none of the claims are intended to embrace subjectmatter that fails to satisfy the requirement of 35 U.S.C. § 101, 102, or103, nor should they be interpreted in such a way.

What is claimed is:
 1. A system, comprising: a first actuable componentconfigured to couple to a plunger of a first syringe containing amedication; a second actuable component configured to couple to aplunger of a second syringe containing the medication; at least one flowsensor configured to obtain a measured flow rate of the medication in aninfusion line coupled to at least one of the first syringe or the secondsyringe; a display; and a processor configured to: operate the firstactuable component to move the plunger of the first syringe at a firstrate; operate the second actuable component to move the plunger of thesecond syringe at a second rate while operating the first actuablecomponent at the first rate; receive one or more patient vital signshaving first monitoring limits during operation of the first syringeonly; set second monitoring limits of the one or more patient vitalsigns tighter than the first monitoring limits during a transitionperiod from the operation of the first syringe only to operation of thesecond syringe only; operate the display to provide a message thatdescribes a decrease in the first rate and a corresponding increase inthe second rate; and operate the display to generate, based on themeasured flow rate, an alert that a scheduled adjustment of the firstrate or the second rate did not occur.
 2. The system of claim 1, whereinthe processor is further configured to: operate the display to provide amessage that describes a further decrease in the first rate and acorresponding further increase in the second rate; and operate thedisplay to provide an icon that visually indicates one of a currentlyincreasing flow rate or a currently decreasing flow rate of the firstsyringe.
 3. The system of claim 1, wherein the processor is furtherconfigured to: operate the display to generate, based on the measuredflow rate, an alert that a combined flow rate corresponding to the firstrate and the second rate is not equal to a target flow rate; and operatethe display to provide a ward view comprising information for multiplesets of the first syringe and the second syringe.
 4. The system of claim1, wherein the message comprises instructions to decrease the first rateand increase the second rate.
 5. The system of claim 1, wherein thesecond rate is an initial priming rate to prime the second syringe. 6.The system of claim 1, wherein the processor is configured to revert thefirst actuable component and the second actuable component back to flowrate settings of an immediately preceding step based on exceeding thetightened second monitoring limits of the one or more patient vitalsigns.
 7. A computer-implemented method, comprising: operating a firstsyringe to administer a medical fluid from the first syringe; detectinga second syringe; obtaining, from at least one flow sensor, a measuredflow rate of the medical fluid in an infusion line coupled to at leastone of the first syringe or the second syringe; receiving, from one ormore vital sign monitors, one or more patient vital signs having firstmonitoring limits during the operation of the first syringe only;setting, by a processor, second monitoring limits of the one or morepatient vital signs tighter than the first monitoring limits during atransition period from the operation of the first syringe only tooperation of the second syringe only; providing one or more guided relaymessages to a user for transitioning from administering the medicalfluid from the first syringe to administering the medical fluid from thesecond syringe; and providing an alert, based on the measured flow rate,that a scheduled adjustment of a flow rate from one of the first syringeor the second syringe did not occur.
 8. The method of claim 7, whereinthe transitioning from administering the medical fluid from the firstsyringe to administering the medical fluid from the second syringecomprises, during the transition period, providing the medical fluidsimultaneously from the first syringe and the second syringe for atleast a portion of the transition period.
 9. The method of claim 8,wherein the transitioning from administering the medical fluid from thefirst syringe to administering the medical fluid from the second syringefurther comprises, during the transition period, periodically reducing afirst flow rate of the medical fluid from the first syringe andcorrespondingly increasing a second flow rate of the medical fluid fromthe second syringe.
 10. The method of claim 9, wherein the providing theone or more guided relay messages comprises providing a first guidedrelay message that includes instructions to the user to increase thesecond flow rate of the medical fluid from the second syringe and reducethe first flow rate of the medical fluid from the first syringe.
 11. Themethod of claim 10, wherein the providing the one or more guided relaymessages comprises providing a second guided relay message that includesa time until a next adjustment of the first flow rate and the secondflow rate.
 12. The method of claim 11, wherein the providing the one ormore guided relay messages comprises providing a third guided relaymessage that includes the alert that the scheduled adjustment did notoccur.
 13. The method of claim 11, wherein the providing the one or moreguided relay messages comprises providing a third guided relay messagethat includes an alert that a combined flow rate corresponding to thefirst flow rate and the second flow rate is not equal to a target flowrate.
 14. The method of claim 7, wherein the operating the first syringecomprises operating the first syringe with a pump.
 15. The method ofclaim 7, wherein the providing the one or more guided relay messagescomprises providing the one or more guided relay messages using adisplay of an infusion pump, the display operated by a guided relaysystem of the infusion pump, wherein the display is operated to providefirst icons that each visually indicate one of a currently increasingflow rate or a currently decreasing flow rate of the first syringe andthe second syringe, respectively, and provide second icons that visuallyindicate each of the first syringe and the second syringe that areundergoing guided relay.
 16. An infusion pump comprising processingcircuitry and non-transitory machine-readable media, the non-transitorymachine-readable media storing instructions that, when executed by theprocessing circuitry cause the processing circuitry to: operate a firstsyringe that is coupled to the infusion pump to move a medical fluidfrom the first syringe into an infusion tubing; detect a second syringecoupled to the infusion pump; obtain, from at least one flow sensor, ameasured flow rate of the medical fluid in an infusion line coupled toat least one of the first syringe or the second syringe; receive one ormore patient vital signs having first monitoring limits; set secondmonitoring limits of the one or more patient vital signs tighter thanthe first monitoring limits during a transition period of the firstsyringe and the second syringe; provide one or more guided relaymessages on a display of the infusion pump for transitioning fromadministering the medical fluid from the first syringe to administeringthe medical fluid from the second syringe; and provide an alert, basedon the measured flow rate, that a scheduled adjustment of a flow ratefrom one of the first syringe or the second syringe did not occur. 17.The infusion pump of claim 16, wherein the one or more guided relaymessages includes a time until an adjustment of a first flow rate forthe first syringe and a corresponding adjustment of a second flow ratefor the second syringe.
 18. The infusion pump of claim 17, wherein thecorresponding adjustment of the second flow rate is equal and oppositeto the adjustment of the first flow rate.
 19. The infusion pump of claim17, wherein the one or more guided relay messages comprises an alertthat a scheduled adjustment of the first flow rate or the second flowrate did not occur.
 20. The infusion pump of claim 17, wherein the oneor more guided relay messages comprises an alert that a combined flowrate corresponding to the first flow rate and the second flow rate isnot equal to a target flow rate.